Psoriasis is a chronic inflammatory immune-mediated proliferative skin disorder that predominantly involves the skin, nails, and joints.1,2

In 2014, Member States of the World Health Organization (WHO) recognized psoriasis as a serious non-communicable disease and adopted the resolution of the World Health Assembly (WHA), which calls for multilateral efforts to raise awareness and fight stigma. The worldwide prevalence of psoriasis is estimated to be approximately 1–3%.2,3

Although psoriasis is not usually a life-threatening disease, several studies have shown that it has a significant impact on medical resource consumption in affected patients.4,5

Despite the economic burden of psoriasis for the patient and for society as reported by several authors,6–8 scant information exists regarding the impact and burden of the disease in Argentina. To better understand this impact, the objective of this study was to estimate medical resource consumption and direct health care costs for patients with moderate/severe psoriasis in Buenos Aires, Argentina from the perspective of the payer.

A retrospective, epidemiological, and observational study was conducted. The population studied included the members of the Italian Hospital Medical Care Program (IHMCP), a prepaid health maintenance organization. The IHMCP provides comprehensive medical and health services through two main hospitals and 24 medical offices to more than 164,456 members, primarily located in the urban areas within the autonomous city of Buenos Aires in Argentina. The city covers an area of 202km2 and has a subtropical climate. It is located on the western bank of the Río de la Plata and has a population of 2,890,151.9 All patients who were diagnosed with moderate/severe psoriasis (severity was defined as receiving systemic treatment) during January 2010–January 2014, 18 years and older, who were members of the IHMCP and with at least 18 months of follow-up, were included in the study.6 Multiple methods of case retrieval were used to ensure complete ascertainment: (1) patients included in dermatology databases; (2) patients with the International Classification of Primary Care code in the IHMCP computer-based patient record system; and (3) patients with the International Classification of Diseases, Ninth Revision code on admission to hospital. Each potentially eligible subject underwent a standard procedure (clinical exam and biopsy) to confirm the diagnosis by dermatology experts. The study protocol and questionnaire were approved by the Ethics Committee before the initiation of the study.

With the introduction of biologics over the past years, there has been a marked shift in treatment modalities that has resulted in a great need for the updating of costs.8 This is the first study performed in Argentina and in the region that evaluates the costs of psoriasis by taking into consideration the direct medical costs of the disease in the moderate-to-severe stage. Mean annual cost per patient was estimated at US$ 5326.

This study is consistent with previous cost-of-illness studies performed in Germany and some European countries.6,8,12 In Germany, Jungen et al. evaluated primary data on 1158 patients collected in a real care setting (a random sample from 132 centers across Germany).8 The mean cost was € 5543 (median € 2030).8 The total costs found by other authors range from € 1079 per patient per year in Spain, from € 387 to € 6398 in Switzerland (including biologics), and € 11,434 in Italy (PASI>20).13 Variations in costs can be explained by year of data, differences in health care systems (especially pricing of medication), and methodological differences such as payer perspective and severity of disease.13 In Germany, in moderate-to-severe plaque-type psoriasis, the out-of-pocket costs were estimated to be € 794 per year on average (15% of the mean total costs of that study).6 Berger et al. estimated € 562 (20% of the mean total costs of that study).14 Another study performed in nine states of the United States, which included 200 patients with moderate-to-severe psoriasis and evaluated health care resources for six months, showed that the direct cost in that population was US$ 11,291 and indirect costs were US$ 2101.12 In that group of patients, 79.5% were prescribed one or more biologic medications for psoriasis to control the disease.12

The present study has many limitations. First, the sample involves patients from only one center. Therefore, a larger sample that involves more centers would be necessary to generalize the results. The second limitation is the way the information was obtained (retrospectively, by collecting information from medical records). Nevertheless, considering that the patients from the IHMCP are seen solely in its own centers and that all medical records are registered, the possibility of bias is low. The third limitation is that indirect costs were not obtained.

In Argentina, this is the first study designed to capture the economic burden of the disease. The important and novel information provided about the disease-related economic burden is the main contribution of this study to the existing literature for psoriasis both in Argentina and the region in terms of costs in a developing country. This information is a valuable tool for relevant and wise decision-making in the field by understanding the exact behavior of the disease in the local setting, and is supplementary to the use of information from Europe and North America, where both resource utilization and costs may be quite different from those observed in a developing country like Argentina.2,7

In conclusion, the study provides important information about the economic burden of the disease in Argentina. Future research performed here as well as in other countries of the region, taking into consideration direct and indirect costs of the disease, will expand knowledge and improve management of the disease in the region, an issue of great importance.

None declared.

María Laura Galimberti: Approval of the final version of the manuscript; conception and planning of the study; elaboration and writing of the manuscript; obtaining, analyzing, and interpreting the data; effective participation in research orientation; intellectual participation in propaedeutic and/or therapeutic conduct of the cases studied; critical review of the literature; critical review of the manuscript.

Aldana S. Vacas: Approval of the final version of the manuscript; obtaining, analyzing, and interpreting the data; critical review of the literature.

Barbara A. Hernández: Approval of the final version of the manuscript; obtaining, analyzing, and interpreting the data; critical review of the literature.

María L. Bollea Garlatti: Approval of the final version of the manuscript; obtaining, analyzing, and interpreting the data; critical review of the literature.

María J. Cura: Approval of the final version of the manuscript; obtaining, analyzing, and interpreting the data; critical review of the literature.

Ricardo L Galimberti: Approval of the final version of the manuscript; obtaining, analyzing, and interpreting the data; critical review of the literature.

None declared.